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Picture by M Kumar, Associated Press

Department of Infectious Diseases, Institute for BiomedicineThe Sahlgrenska Academy at the University of Gothenburg

E-mail: joakim.larsson@fysiologi.gu.sePersonal website: http://www.biomedicine.gu.se/joakimlarssonCARe website: www.care.gu.se

D. G. Joakim Larsson, Professor in Environmental PharmacologyDirector, Centre for Antibiotic Resistance Research at University of Gothenburg (CARe)

The environmental dimensions of antibiotic resistance

For copyright reasons, some pictures have been removed from this online presentation. I would like to take the liberty of suggesting you to take a look at some of my recorded lectures online, or some of the documentary films made

on the topic. This material can be found on:

http://biomedicine.gu.se/ominst/avd/infektion/forskare/joakim_larsson/prizes_lectures_and_media

For more reading, please see:

http://biomedicine.gu.se/ominst/avd/infektion/forskare/joakim_larsson/Publications

The role of the environment in antibiotic resistance:

1. Transmission

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Photo: Reuters/D Boylan

Contaminated water as a route for spreading bacterial pathogens

Picture removed

The role of the environment in antibiotic resistance:

2. Emergence

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Antibiotic resistance genes are ancient

vanXbla

tetM

Nature (2011) 477:457-61Slide courtesy: Gerry Wright

Picture removed

Resistance i harmless bacteria Resistance in pathogens

Emergence of resistance is promoted by a selection pressure from antibiotics

This transfer of resistance genes could be a rare, or even one-time event

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… so where do these critical genetictransfer events occur?

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… so in what environments do we findsufficiently high concentrations of

antibiotics to select for resistance?

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pg/L ng/L µg/L mg/L

EU waters

STPs

Industrial

Clear evidence for selection still lacking

Antibiotic concentrations commonly found in different types of environments:

Animal farming

Patancheru, India Major production of human and veterinary antibiotics to the world market

Photo: C. de Pedro (2006)• Larsson DGJ, de Pedro C, Paxeus N. 2007. J Haz Mat. 148 (3), 751-755 • J Fick, H Söderström, RH Lindberg, Chau DNP, M Tysklind, DGJ Larsson 2009 Env Toxicol Chem 28:2522–2527• Kristiansson E, Fick J, Janzon A, Grabic R, Rutgersson C, Weidegård B, Larsson DGJ. PLoS ONE, 2011 6(2): e17038

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Pollution level by excretedantibiotics (usage)

Ciproflaxin 30 mg/L

Ciprofloxacin 30 ng/L

Pollution level by industrialcontamination (production)

Larsson DGJ. (2014) Pollution from drug manufacturing: review and perspectives. Philosophical Transactions of the Royal Society B, 369: 20130571.

Breeding grounds for exceptionally multiresistant bacteria!

Photo C de Pedro, 2006

Marathe NP, Regina VR, Walujkar SA, Charan SS, Moore ERB, Charan SS, Moore ERB, Larsson DGJ, Shouche YS. (2013) A Treatment Plant Receiving Waste Water from Multiple Bulk Drug Manufacturers Is a Reservoir for Highly Multi-Drug Resistant Integron-Bearing Bacteria. PLoS ONE 8(10): e77310.

Johnning A, Moore ERB, Svensson-Stadler L, Shouche YS, Larsson DGJ, Kristiansson E. (2013) The acquired genetic mechanisms of a multi-resistant bacterium isolated from a treatment plant receivingwastewater from antibiotic production. Appl. Environ. Microbiol., 79(23):7256.

Flach CF, Johnning A, Nilsson I, Smalla K, Kristiansson E, Larsson DGJ. (2015) Isolation of novel IncA/C and IncN fluoroquinolone resistance plasmids from an antibiotic-polluted lake. Journal of AntimicrobialChemotherapy. 70(10):2709-2717

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Picture by M Kumar, Associated Press

Picture removed

Transmission is global -resistance is everyones concern

Johnning A, Kristiansson E, Martin A, Marathe NP, Shouche YS, Johansson A, Larsson DGJ. (2015) Quinolone resistance mutations in the

faecal microbiota of Swedish travellers to India.

BMC Microbiology. 15:235.

Bengtsson-Palme J, Angelin M, Huss M, Kjellqvist S, Kristiansson E, Palmgren H, Larsson DGJ, Johansson A. (2015) The human gut microbiome as a transporter ofantibiotic resistance genes between continents. AntimicrobialAgents and Chemotherapy. doi: 10.1128/AAC.00933-15

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These factories produce the drugs we all use!

Larsson DGJ and Fick J. 2009. Transparency throughout the production chain – a way to reduce pollution from the manufacturing of pharmaceuticals. Regulatory Toxicology and Pharmacology. 53:161-163.

….so what should we do about it?

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Centre for Antibiotic Resistance Research at University of Gothenburg

E-mail: joakim.larsson@fysiologi.gu.sePersonal website: http://www.biomedicine.gu.se/joakimlarssonCARe website: www.care.gu.se